New Wine in Old Bottle: Late-life Psychosis

Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, Mail Code 0664, La Jolla, San Diego, CA 92093, USA.
The Psychiatric clinics of North America (Impact Factor: 1.87). 06/2011; 34(2):295-318, vii. DOI: 10.1016/j.psc.2011.02.008
Source: PubMed


Psychosis is common in late-life and exacts enormous costs to society, affected individuals, and their caregivers. A multitude of etiologies for late-life psychosis exist, the two most prototypical being schizophrenia and psychosis of Alzheimer disease (AD). As such, this article focuses on the nonaffective, neuropsychiatric causes of chronic psychosis in the elderly, specifically schizophrenia, delusional disorder, and the psychosis of AD and other dementias.

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    • "Nevertheless, not many studies have investigated the interaction between AD and SCZ. Most investigations of the two diseases have focused on the differential diagnosis of AD with delusion from late-onset SCZ or delusional disorder [2]. In addition, as originally termed dementia praecox by Kraepelin, some of the patients with SCZ show cognitive deterioration without the neuropathology of neurodegenerative disease [3] [4], which hampers AD diagnosis in patients with a history of SCZ. "
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    ABSTRACT: Although both schizophrenia (SCZ) and Alzheimer's disease (AD) are among the most common psychiatric diseases, the interaction of these two is not well-understood. We investigated three women with SCZ who developed AD in their 60s. The patients presented with cognitive dysfunction such as loss of recent memory, which was confirmed by both clinical observations and neuropsychological tests. Their magnetic resonance and functional imaging findings were consistent with AD. Their brain atrophy advanced significantly during a 6-year observation period. However, their global cognitive function did not deteriorate significantly during this period. Although the cognitive reserve model might account for this discrepancy, our results suggest some interactions between the neuropathology of SCZ and AD and warrant further research.
    08/2015; 2015(8):968598. DOI:10.1155/2015/968598
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    ABSTRACT: To compare the clinical and neurocognitive profile of early-onset (EOP, <40 years), late-onset (LOP, 40-59 years) and very-late-onset (VLOP, ≥60 years) psychosis. Cross-sectional observational study. Secondary, tertiary, and community mental health care. Patients with a DSM-IV diagnosis of non-affective psychotic disorder were included from two complementary studies (GROUP and PSITE) on genetic and environmental risk factors of psychosis in the Netherlands and Belgium. Main outcome measures were the severity of positive and negative symptoms, quality of life, and age-corrected scores on measures of general intelligence, verbal memory, attention, and executive function. One-year follow-up data were used to validate diagnoses and exclude participants with possible or probable dementia. 286 EOP (85%), 24 LOP (7%) and 28 VLOP (8%) participated. VLOP patients reported significantly more positive symptoms than EOP patients. Age-at-onset groups had similar age-corrected scores on IQ, verbal memory, attention and executive functions. A significantly better performance was found in VLOP compared with LOP on the CAMCOG total score, though scores were still within the normal range. After controlling for possible confounding, however, VLOP differed significantly on an attention accuracy task compared with LOP patients. Re-entering data for probable dementia patients (N = 4) did change the results regarding cognition outcomes. VLOP patients show more positive symptoms but do not appear to differ on neuropsychological tests from EOP and LOP when age is controlled for. This questions the idea that VLOP is the expression of underlying neurodegeneration. Copyright © 2014 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.
    The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry 11/2014; 23(8). DOI:10.1016/j.jagp.2014.10.007 · 4.24 Impact Factor
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    ABSTRACT: Background: The prevalence and overlap of psychotic symptoms among patients with dementia compared to those with delirium superimposed to dementia have received little attention. The aim of our study was to investigate the overlapping and distinguishing capability of psychotic symptoms among patients with dementia or with delirium superimposed to dementia, and to clarify their prognostic value. Methods: We assessed 255 residents with dementia in nursing homes and acute geriatric wards for psychotic symptoms and delirium. The residents were divided into three groups: those with delirium (Group 1; n = 66), those with psychotic symptoms without delirium (Group 2; n = 74), and without psychotic symptoms or delirium (Group 3; n = 115). Results: Of the participants, 30.9% suffered from delusions, 22.1% from visual hallucinations and 14.2% from auditory hallucinations. Delusions occurred more often in Group 2 than in Group 1. Of the subjects in Group 3, 6.5% suffered from misidentifications, whereas the respective figures in Groups 1 and 2 were 17.5% and 20.8%, respectively. Of those suffering from psychotic symptoms (n = 109), one in three (n = 35) suffered delirium, and two in three (n = 74), psychotic symptoms without delirium. In the adjusted Cox proportional hazard model with Group 2 as the referent, we found no difference between the groups in mortality rates (Group 1: HR 0.98, 95% CI: 0.64-1.52 and Group 3: HR 1.49, 95% CI: 0.92-2.42). Conclusions: Psychotic symptoms cannot be used to distinguish patients with dementia from those with delirium superimposed to dementia. © 2015 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.
    European geriatric medicine 01/2015; 6(3). DOI:10.1016/j.eurger.2014.12.002 · 0.73 Impact Factor
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